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General NPI Number Information
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NPI Number | 1699410266
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Entity Type | Individual
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Provider Name | JONATHAN BRICK DO
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Gender | Male
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 4502 MEDICAL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4402
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Country | US
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Telephone | 210-562-5824
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Fax |
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Provider Business Mailing Address
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Address Line | 3684 DOVER CENTER RD
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City | WESTLAKE
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State | OH
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Zip | 44145-5432
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Country | US
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Telephone | 440-376-8487
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | BP10078528
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License Number State | TX
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